Ear reconstruction an art and a science

BOSTON - Dr. Tessa Hadlock said ear reconstructive surgery has advanced enormously over the past 30 years, in terms of looking natural and matching the other ear.

Thirty years ago, the results were “poor,” 20 years ago “okay,” ten years ago “okay to good” and today “good to great,” said Hadlock, chief of facial plastics at Mass. Eye and Ear in Boston.

External ear reconstruction was invented in the early 1950s by the pioneering surgeon Radford C. Tanzer after he saw his first microtia patient, a child born with a missing ear.

“It didn’t look good. It was basically a potato chip on the head, but the concept had been born of taking rib cartilage and carving it into an ear,” said Hadlock, who performed an ear reconstruction on Norton teacher and Taunton native Shawn Oakley in August.

Since then the techniques have been refined and gotten progressively more elegant, she said.

Oakley’s new ear is already a convincing match for his other ear, in terms of size and shape – though it sits closer to his head than the other ear.

That’s because the surgery is done in stages and Oakley will have a second surgery in April to better position his ear and create a space between the upper ear and the side of his head.

At that point, it might be hard to tell it wasn’t the ear he was born with.

Hadlock said ear reconstruction is as much an art as a science.

The first step is to draw a template from the “normal” ear using x-ray paper.

The next step is to remove the cartilage from the ribs, which is done by her colleague Dr. David Shaye.

“Then he and I together take the fragments and carve them into the building blocks of the ear,” she said.

They stretch the existing skin and remove any malformed cartilage to make room for the new ear and put in suction drains so the skin adheres to the new ear, she said.

The cartilage stays alive by being adjacent to skin, which gives it its blood supply.

Rib cartilage is used because there’s a lot of it and it’s the only cartilage in the body that’s dispensable, Hadlock said.

Ear reconstruction isn't just used in cases of birth defects like microtia, which translates to “little ear” and is usually unilateral.

The technique is also used in cases of external ear loss or damage due to accident, skin cancer or burns, she said.